Psychostimulant Use and Fatal Stroke in Young Adults

Abstract

Psychostimulant use is associated with increased stroke risk. To determine the proportion of psychostimulant users among fatal strokes in young adults (15–44 years), all cases were retrieved from the National Coronial Information System (1/1/2009–31/12/2016). A total of 279 cases were identified: hemorrhagic (259), ischemic (8), thrombotic (8), and mycotic (4). Fifty (17.9%) were identified as psychostimulant users. Psychostimulants in blood were detected in 37/45 where toxicology was available, predominantly methamphetamine (32/45). Hemorrhagic strokes in the psychostimulant group were more likely to be intraparenchymal (OR 2.33). Psychostimulant users were less likely to be obese (OR 0.31), but more likely to have a history of tobacco use (OR 2.64). No psychostimulant user had a previous stroke history, was gravid/postpartum, or diagnosed with cerebral vasculitis or endocarditis. The work illustrates the substantial role of psychostimulant use in fatal strokes among young adults. In cases of hemorrhagic stroke among young adults, psychostimulant use should be considered.

The Association between Substance Use Disorders and Long-Term Outcome of Stroke: Results from a Population-Based Study of Stroke among 450,229 Urban Citizens

“…Substance use disorders (SUD) may be a direct or indirect risk factor for stroke [1-7]. The relationship between illicit drugs and stroke incidence, especially in young adults, has been reported in several studies [1, 2, 8]. However, little is known regarding long-term stroke outcome in substance users.…”

Moyamoya vasculopathy in a young Caucasian woman with significant methamphetamine use

“…11 An Australian nation-wide study found that one in five fatal strokes among those aged 15-44 involved psychostimulants, of which methamphetamine was the most common substance implicated. 12 However, incidence of moyamoya vasculopathy in patients with psychostimulant use is unknown due to a lack of sufficient data. 11 To our knowledge, only one case has ever been reported of moyamoya vasculopathy being found in a patient presenting with poly-drug overdose.…”

Psychostimulant use disorder and the heart

“…Hypertension associated with psychostimulant use can be either transient or permanent, and in the setting of a hypertensive crisis or sudden blood pressure spike can result in haemorrhagic and, less commonly, ischaemic strokes, subarachnoid haemorrhage , possibly cerebral vasculitis and seizures .…”

“…Persistent systemic hypertension, irrespective of cause, is a potent predisposing factor for stroke, especially where haemorrhagic in nature, and more than 60% of all ischaemic and haemorrhagic stroke patients present to the emergency department with an elevated blood pressure . It is therefore not surprising that psychostimulant users have a higher rate of stroke and that the majority of the strokes identified in an autopsy series were haemorrhagic in nature . In that series, methamphetamine found in 84% of cases and cocaine in 8% were the most commonly used psychostimulants, although other psychostimulants identified on toxicological testing included MDMA in 6%, dimethylamylamine (DMAA) in 4% and phentermine in 2%.…”